Disruption of Transitions in High-Risk Substance Use from Adolescence to Young Adulthood: School, Employment, and Romantic Relationship Factors

How the War on Drugs Impacts Social Determinants of Health Beyond the Criminal Legal System

There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the "war on drugs" in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that "drug war logic" has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts.

KEY MESSAGES

• A drug war logic that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment.• The U.S. drug war's frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others.• Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform.Appeared originally in Ann Med 2022; 54:2024-2038.

Household Compositions and Substance Use among Young Adults in the U.S

BACKGROUND

Adults aged 21-29 have the highest past-month prevalence of tobacco, alcohol, and illicit drug use in the U.S. Currently, young adults often delay traditional adulthood milestones (e.g., marriage and childbearing), which may impact their household composition and substance use.

METHODS

We examined how the past-month prevalence of eight mutually exclusive substance use outcomes varied by household composition among young adults using the 2016-2019 National Surveys on Drug Use and Health (NSDUH) data. Bivariable and multivariable multinomial logistic regression analyses were applied.

RESULTS

Among young adults residing with their children, the most common household composition was residing with children and a spouse/partner (16.6%, 95% CI = 16.5-16.8%). Among those residing without children, common household compositions included residing with parents (22.8%, 95% CI = 22.2-23.4%) and residing only with a spouse/partner (17.9%, 95% CI = 17.6-18.3%). Past-month prevalence of binge alcohol, tobacco, and illicit drug use varied by household composition. Residing only with children and a spouse/partner was associated with a low prevalence of most examined substance use patterns. Across household compositions, those residing solely with unrelated individuals had the highest adjusted prevalence of tobacco, drug, and binge alcohol use (13.8%, 95% CI = 12.5-15.1%).

CONCLUSIONS

The prevalence of substance use patterns among U.S. young adults varies by household composition. Those residing solely with unrelated individuals had the highest prevalence of tobacco, binge alcohol, and drug use. The presence of a young adult's own children and a spouse/partner is associated with a lower prevalence of most examined substance use patterns. As household compositions continue to diversify, targeted substance use prevention/treatment strategies may be needed.

Longitudinal patterns of polysubstance use throughout adolescence: association with adult substance use and psychosocial outcomes controlling for preadolescent risk factors in a male cohort

PURPOSE

Inconsistent reports raise the question of the extent to which poor adult outcomes are associated with adolescent polysubstance use (PSU: alcohol, marijuana, other illicit drugs) above and beyond earlier risk factors.

METHODS

Early adulthood substance-related and psychosocial outcomes were examined in association with age 13 to 17 developmental patterns of PSU in boys from urban, low SES neighborhoods (N = 926). Three classes obtained by latent growth modeling described low/non-users (N = 565, 61.0%), lower risk PSU (later onset, occasional use, 2 ≤ substances; N = 223, 24.1%), and higher risk PSU (earlier onset, frequent use, 3 ≥ substances; N = 138, 14.9%). Preadolescent individual, familial and social predictors of adolescent PSU patterns were used as covariates.

RESULTS

Adolescent PSU contributed to both age-24 substance-related outcomes (frequency of alcohol, drug use, and getting drunk, risky behaviors under influence, and use-related problems) and psychosocial outcomes (no high school diploma, professional or financial strain, ASP symptoms, criminal record) over and above preadolescent risk factors. Controlling for preadolescent risk factors, adolescent PSU made a more important contribution to adult substance use outcomes (increasing the risk by about 110%) than to psychosocial outcomes (16.8% risk increase). PSU classes showed poorer adjustment for all age-24 substance use, and for various psychosocial outcomes than low/non-users. Higher risk polysubstance users also reported poorer outcomes than their lower risk peers for most substance use outcomes, and for professional or financial strain and criminal record.

CONCLUSION

Findings highlight the contribution of adolescent PSU in a dose-response fashion, over and above preadolescent risk factors, on both homotypic and heterotypic outcomes in early adulthood.

How the war on drugs impacts social determinants of health beyond the criminal legal system

There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the "war on drugs" in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that "drug war logic" has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts. KEY MESSAGESA drug war logic that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment.The U.S. drug war's frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others.Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform.

The Protective Role of Grit against Alcohol and Cannabis Use through Young Adulthood

Introduction: Problematic substance use in young adulthood is consistently related to negative outcomes later in life. Understanding the factors that protect against problematic substance provides opportunities for early preventive intervention. We examine the protective role of grit - passion and perseverance for long-term goals - on substance use through young adulthood, a period of heightening risks for substance use. Methods: In this research, we use cross-lagged panel models and data from the Victoria Healthy Youth Survey (N = 477, 52% female) to test the reciprocal within-time associations and the directional relationships between grit (passion and perseverance) and substance use (cannabis and alcohol) across three assessments (6 years, ages 18-29). All models controlled for sex and SES. Results: Significant findings show negative within-time associations between passions and perseverance and cannabis use at T1 (ages 18-24) and at T2 (ages 20-26), and significant, negative within-time associations between passion and perseverance and alcohol use (heavy episodic drinking) at T1 but not at T2. No significant across-time associations between passion and perseverance and substance use were found. Conclusion: Preventive interventions to enhance passion and perseverance may provide important targets for interventions for young adults to reduce current substance use. However, grit did not have an effect beyond the stability of cannabis use or alcohol use over time, suggesting effects may act by substituting proactive goals for current substance use.